Can liver disease be cured?

The liver is the largest internal organ and a vital part of the human body. It is usually located in the upper part of the abdomen (stomach) on the right side. 

Some of the liver’s vital functions include - 

• Breakdown and storage of the food we eat as energy
• Breakdown of drugs and other harmful substances
• Production of proteins that help in blood clotting when you are injured
• Maintenance of blood sugar and cholesterol levels within normal ranges

The liver is often able to cure itself after it has been injured by forming new cells. However, sometimes when the injury is massive (paracetamol overdose) or repeated (alcohol misuse), the liver loses its ability for renewal leading to liver failure. Not all liver diseases are curable.

Most diseases of the liver result in hepatitis - an inflammation (swelling) of the liver. Hepatitis, which lasts for a long time, can lead to irreversible scarring of the liver (cirrhosis).

What are common liver diseases?

Liver diseases can be classified based on their causes as follows:

• Viral hepatitis - this is a liver disease caused by viral infection(s) of the liver. Various viruses can cause viral hepatitis; these include hepatitis A, hepatitis B, hepatitis C, hepatitis D, hepatitis E, and yellow fever viruses. 
• Alcohol-related liver disease - excess alcohol consumption can cause liver damage, leading to a spectrum of liver diseases. These range from reversible alcoholic fatty liver disease to more serious but potentially reversible alcoholic hepatitis. Alcoholic cirrhosis (scarring of the liver) is irreversible, and it is the most severe form.
• Non-alcoholic fatty liver disease (NAFLD) - is caused by an abnormal collection of fat within the liver. Your risk of developing NAFLD is increased if you are overweight/obese, have type 2 diabetes, high blood pressure, high cholesterol, or have metabolic syndrome. Like an alcohol-related liver disease, NAFLD also occurs in stages, ranging from alcoholic steatosis, non-alcoholic steatohepatitis (NASH), fibrosis, and alcoholic cirrhosis.
• Poisonings - one example is paracetamol overdose which can cause severe liver injury. 
• Genetic liver diseases - inherited conditions like haemochromatosis (iron build-up in the liver), Wilson's disease (copper build-up), and alpha-1 antitrypsin deficiency can cause liver damage.
• Autoimmune conditions - the immune system is the body’s defence against foreign organisms like bacteria and viruses. Sometimes, this system erroneously identifies parts of the body as foreign and attacks them. In conditions like autoimmune hepatitis and primary biliary cholangitis, the liver is a target for immune attack, and it becomes damaged in the process.
• Other infectious causes - non-viral infectious forms of liver disease include hydatid disease/echinococcosis and hepatic schistosomiasis
• Liver cancer - here, an abnormal group of cells that grow fast and kill surrounding normal cells are found in the liver. Cancer can start in the liver, or it could start from another organ and spread into it (metastasis). 

What are the skin signs of liver disease?

There are signs that can be seen on the skin in people with liver disease, these include:^1,2

• Yellowing of the skin and the whites of the eyes (jaundice)
• Itchy skin with consequent scratch marks
• Reddening of the palms (palmar erythema)
• Whitening of the nails (leukonychia)
• Development of breast tissue in men (gynaecomastia)
• Loss of armpit hair
• A spider-like rash (spider naevi)
• Easy bruising or bleeding

Where does liver rash appear?

Spider naevi/angiomas are so-called because they appear as central red dots with tiny blood vessels radiating from them (like the legs of a spider). This rash is usually found on the arms, chest, back and face.

Where do you feel liver problems?

You could feel pain in the upper right-hand side of your tummy if you have liver disease. The pain could also be felt all over your tummy if it is swollen from too much water collecting in it (ascites). You could also be bothered by itching all over your skin.

What organs are affected by liver disease?

Liver disease can have profound effects on other organs; it can affect the kidneys causing hepatorenal syndrome the lungs causing hepatopulmonary syndrome and the heart as well.^3,4,5

Liver disease can also cause a number of complications which include:

• Ascites - an abnormal accumulation of fluid in the tummy that makes it swell up.
• Portal hypertension - an increase in the blood pressure within the liver. This can cause some blood vessels to burst, resulting in bloody vomit.
• Hepatic encephalopathy - this can be caused by infections, constipation, dehydration, and some drugs. The liver normally removes harmful chemicals from the blood. When it is diseased and unable to do this, some of these chemicals, like ammonia, build up in the blood and affect the brain leading to symptoms like confusion, mood or personality changes, sleep disturbances, and seizures. 

Which treatment is best for liver disease?

While there are treatments for liver disease, these are often cause-based, and there is no single best treatment. Liver disease prevention is therefore, paramount. Useful measures to take include:

• Do not drink excess amounts of alcohol
• Lose weight/maintain a healthy weight  
• Speak to your doctor before you start taking any drugs and inform them about drugs you are already taking
• Speak to your doctor about testing for and the prevention/treatment of viral hepatitis
• You can also minimize your risk of liver disease by maintaining normal blood pressure, blood sugar and cholesterol levels. 

When can you get liver disease?

You can develop liver disease if you:

• Drink excessive amounts of alcohol
• Have an infection that affects the liver
• Have taken something poisonous to the liver (some drugs, toxins)
• Have a close relative with inheritable liver disease 
• Have type 2 diabetes, high blood pressure, high cholesterol or are overweight/obese

What is the difference between a gastroenterologist and hepatologist?

A gastroenterologist is a specialist doctor who diagnoses and treats diseases involving the digestive tract (from the mouth to the anus) and the liver.

A hepatologist, on the other hand, is a doctor who is specialized in diagnosing and treating diseases of the liver.

Can liver problems cause pain?

Yes, liver problems can cause pain over the location of the liver - the upper part of the tummy on the right - or all over the tummy when there are ascites.